RF-11-23-2810 Inspection Affidavit 10619 NE 11 AvePermit # IZZF - 11
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.pov
23 -- Z 910
DATE: I Z / S /2-3
INSPECTION AFFIDAVIT
lj v e.'-� ,�t`C-V'�- licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
l License #: cCG l j (9 Z S
ti
On or about 0 / �J/ZS EP l z;. , I did personally inspect the roof deck nailing
(Date & time)
work at Il�1nt IV , Lt'` A--e,
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S)
Signatu
State of Florida, Miami Dade County:
The undersigned, being the first duly sworn, deposes and says thaO he is the contractor for
the above property mentioned.
Sworn to and subscribed before me this
day of -PeCeMbCiKi 20-25
IINHELCHEL
IuiY COIAIu11SS
Notary Public, State of Florida at Large l M
l �` ~� �: lON 8 HH 14QTT4
EXP RES: July 7. 2b
8W dW 71vu Harry NNW undMwrRen
For Forms and Applications click here:
http://bidg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1